Prolonged Negative Pressure Wound Therapy Followed by Split-Thickness Skin Graft Placement for Wide Dehiscence of Clamshell Incision after Bilateral Lung Transplantation

A Case Report

H. Suzuki, T. Watanabe, T. Okazaki, H. Notsuda, H. Niikawa, Y. Matsuda, M. Noda, A. Sakurada, Yasushi Hoshikawa, T. Aizawa, T. Miura, Y. Okada

Research output: Contribution to journalArticle

Abstract

Clamshell incision is a standard approach for bilateral lung transplantation, providing a good operative field; however, once wide dehiscence occurs, its management is sometimes difficult because of intense immunosuppression and malnutrition of the recipient. A 22-year-old man with idiopathic pulmonary arterial hypertension underwent cadaveric bilateral lung transplantation through a clamshell incision using standard cardiopulmonary bypass. He developed wound dehiscence on postoperative day (POD) 20 that resulted in exposure of the bilateral fifth ribs and open pneumothorax. Considering the extreme malnutrition and emaciation of the recipient, we avoided initial closure of the dehiscence. After the debridement of necrotic tissue, negative pressure wound therapy was initiated on POD 25 and was continued for approximately 6 months with trafermin spray application. Eventually, the wound, including the fifth ribs, was completely covered with granulation tissue except for the wire tying the sternum. On POD 217, the patient underwent removal of the sternal wire followed by split-thickness skin grafting. His wound was successfully closed and he was discharged without activity limitation on POD 265.

Original languageEnglish
Pages (from-to)982-984
Number of pages3
JournalTransplantation Proceedings
Volume48
Issue number3
DOIs
Publication statusPublished - 01-04-2016

Fingerprint

Negative-Pressure Wound Therapy
Lung Transplantation
Ribs
Transplants
Malnutrition
Skin
Wounds and Injuries
Emaciation
Sternum
Skin Transplantation
Granulation Tissue
Pneumothorax
Debridement
Cardiopulmonary Bypass
Immunosuppression

All Science Journal Classification (ASJC) codes

  • Surgery
  • Transplantation

Cite this

Suzuki, H. ; Watanabe, T. ; Okazaki, T. ; Notsuda, H. ; Niikawa, H. ; Matsuda, Y. ; Noda, M. ; Sakurada, A. ; Hoshikawa, Yasushi ; Aizawa, T. ; Miura, T. ; Okada, Y. / Prolonged Negative Pressure Wound Therapy Followed by Split-Thickness Skin Graft Placement for Wide Dehiscence of Clamshell Incision after Bilateral Lung Transplantation : A Case Report. In: Transplantation Proceedings. 2016 ; Vol. 48, No. 3. pp. 982-984.
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Prolonged Negative Pressure Wound Therapy Followed by Split-Thickness Skin Graft Placement for Wide Dehiscence of Clamshell Incision after Bilateral Lung Transplantation : A Case Report. / Suzuki, H.; Watanabe, T.; Okazaki, T.; Notsuda, H.; Niikawa, H.; Matsuda, Y.; Noda, M.; Sakurada, A.; Hoshikawa, Yasushi; Aizawa, T.; Miura, T.; Okada, Y.

In: Transplantation Proceedings, Vol. 48, No. 3, 01.04.2016, p. 982-984.

Research output: Contribution to journalArticle

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AU - Okazaki, T.

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AU - Sakurada, A.

AU - Hoshikawa, Yasushi

AU - Aizawa, T.

AU - Miura, T.

AU - Okada, Y.

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AB - Clamshell incision is a standard approach for bilateral lung transplantation, providing a good operative field; however, once wide dehiscence occurs, its management is sometimes difficult because of intense immunosuppression and malnutrition of the recipient. A 22-year-old man with idiopathic pulmonary arterial hypertension underwent cadaveric bilateral lung transplantation through a clamshell incision using standard cardiopulmonary bypass. He developed wound dehiscence on postoperative day (POD) 20 that resulted in exposure of the bilateral fifth ribs and open pneumothorax. Considering the extreme malnutrition and emaciation of the recipient, we avoided initial closure of the dehiscence. After the debridement of necrotic tissue, negative pressure wound therapy was initiated on POD 25 and was continued for approximately 6 months with trafermin spray application. Eventually, the wound, including the fifth ribs, was completely covered with granulation tissue except for the wire tying the sternum. On POD 217, the patient underwent removal of the sternal wire followed by split-thickness skin grafting. His wound was successfully closed and he was discharged without activity limitation on POD 265.

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